Project Summary The objectives of this proposal are to facilitate the implementation of loyalty/reward-based programs to increase adherence to medical treatment among patients with substance use disorders through innovative solutions to three challenges. One challenge is that increasingly complicated federal regulations dissuade many hospitals and clinics from implementing loyalty/reward-based programs. Second, loyalty/rewards programs using only monetary incentives can be financially unsustainable. Third, the effectiveness of reward programs may vary based on individual patient characteristics. We propose to address these challenges by 1) Offering health centers educational resources related to regulatory compliance, a questionnaire to self-assess compliance, and an online forum to share experiences; 2) Developing a reward library containing a taxonomy of types, schedules, and formats of monetary and non-monetary rewards used in prior studies and the associated behavior changes they have produced; 3) Systematically review the research literature on the effectiveness of various forms of rewards for patients based on their demographic and psychographic traits. Building on our team?s experience developing software to promote patient appointment attendance, in Phase I a new tool will be created and tested with a sample of ten providers and ten patients who are prescribed but not fully adherent to substance use disorder treatment. These participants will be recruited through our network of university, pharmacy and primary care partners. Patients will receive tailored text messages (in English or Spanish) encouraging adherence, self-report their treatment adherence (which will be verified through smart pill caps and biological testing), earn points for adherence that can be exchanged for rewards customized for them based on a baseline survey, and report their satisfaction with the program and process at the end of the four-week study. This pilot will assess the feasibility and perceived usefulness of the product. If the pilot is successful, a Phase II study will be proposed to use an experimental medicine approach to evaluate the product?s efficacy at increasing adherence to treatment and the mechanisms through which the rewards program works using a Multiphase Optimization Strategy and randomized controlled trial.